Reactions 1225 - 25 Oct 2008

SBupivacaine

Respiratory failure following high spinalanaesthesia in an infant: case report

A 45-day-old male infant developed high spinal anaesthesiaresulting in respiratory failure, after receiving bupivacaine andclonidine.

The boy was scheduled for bilateral inguinal hernia repairand a spinal needle was placed at the L4-L5 interspace. Afteridentifying free flow of CSF, spinal anaesthesia wasadministered as 3.5mg of hyperbaric 0.75% bupivacaine mixedwith clonidine, in a total volume of 0.7mL. He was placed in asupine position, and 5 minutes later he developed paradoxicalbreathing; he had increased abdominal excursion and inwardmovement of the rib cage on inspiration. His respiratorymovements were regular but his oxygen saturation dropped to85%.

The boy was given 100% oxygen via a face mask, thenunderwent tracheal intubation. General anaesthesia wasmaintained with sevoflurane. After 90 minutes, his heart rateincreased, indicating the block was wearing off, so thesevoflurane dosage was increased. After completion of thesurgery he was successfully extubated. He had an oxygensaturation of 99% on room air, with regular breathing, normalmuscle tone of his lower extremities and full consciousness.

Author comment: "As the addition of clonidine does notincrease the extent of sensory or motor block, we do notattribute the occurrence of high spinal anesthesia anddesaturation to the addition of clonidine."Aouad MT, et al. Respiratory failure in a former preterm infant following highspinal anesthesia with bupivacaine and clonidine. Pediatric Anesthesia 18:1000-1001, No. 10, Oct 2008 - Lebanon 801124266

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Reactions 25 Oct 2008 No. 12250114-9954/10/1225-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved